# Fungus Among Us: An 8-Year Retrospective Study of Fungal Infections at a Tertiary-Care Hospital in Bucharest, Romania

## TL;DR

This 8-year study in Romania highlights the prevalence and drug resistance of fungal infections, especially in ICU patients.

## Contribution

The study provides a comprehensive analysis of fungal infection trends and resistance patterns in a Romanian hospital over eight years.

## Key findings

- Candida albicans was the most common pathogen, with only 17% of isolates susceptible to all antifungals.
- Candidozyma auris showed a high fluconazole resistance rate of 96.3%.
- Over half of ICU cases involving Aspergillus species resulted in death.

## Abstract

Despite the devastating consequences of fungal disease, research struggles to catch up to present needs. This study aims to give a broad perspective on the situation, investigating patterns and distribution of fungal pathogens and monitoring trends of resistance to antifungal drugs, over an 8-year timeframe, at the National Institute of Infectious Diseases “Prof. Dr. Matei Balș” in Bucharest, Romania. Samples were inoculated on Sabouraud or Brilliance Candida Agar media; strains were identified using MALDI-TOF MS; and antifungal sensitivity testing was performed using E-Tests strips, VITEK2 Compact and MICRONAUT-AM automatic systems. Candida albicans, accounting for 42% of the positive samples, was the most common pathogen observed, with only 17% of the isolates being susceptible to all antifungals tested, while it was also predominant and deadly in the ICU. The emerging Candidozyma auris, found in 8% of the candidoses, exhibited a fluconazole resistance rate of 96.3%. Of the Aspergillus fumigatus strains, 35.7% showed resistance to azoles, and 25% to amphotericin B. In the ICU, more than half of A. flavus-, A. fumigatus- or A. niger-related cases culminated in death. Antifungal resistance is not to be treated lightly, as it is still a complex and dynamic threat, with devastating consequences.